High-risk pregnancy management delivers both testing and TLC

Managing a high-risk pregnancy is high science for today’s obstetrician, with all the tests available to monitor the mother’s and the baby’s progress. But it also requires a human touch, according to Ravi Shankar, MD, of the Division of Maternal/Fetal Medicine at North Shore University Hospital. This is particularly true when it is the woman’s second high-risk pregnancy. High-risk pregnancy services are a key element at Katz Women’s Hospital at North Shore University Hospital and Katz Women’s Hospital at LIJ Medical Center.

Annamaria Ferri was referred to Dr. Shankar’s practice when she was 36 years old and 12 weeks pregnant. She had suffered two previous losses: an ectopic pregnancy at 12 weeks and a miscarriage at 15 weeks. She had difficulty conceiving and her current pregnancy had been achieved through intrauterine insemination (IUI) performed by Avner Hershlag, MD, at the North Shore-LIJ Health System’s Center for Human Reproduction.

Everything proceeded normally until the 26th week, when Dr. Shankar and his fellow physicians became concerned that the baby was lagging in growth. They were also concerned that Doppler ultrasound indicated insufficient blood flow to the baby.

At 29 weeks, the baby’s dropping heart rate was revealed by a nonstress test. The attending physicians held a team meeting and decided it was time to deliver the baby. The parents were very familiar with the complexities of fetal testing, and they gave consent. Ms. Ferri had already been given two courses of steroids, which would benefit the baby’s lungs. On August 13, 2009, Dr. Shankar performed a cesarean section and tiny Luigi Ferri —weighing l pound, 13 ounces — entered the world.

“With recent advances in neonatology, babies Luigi’s size can be very viable,” Dr. Shankar said, “and Luigi is doing just fine.” He speaks from direct observation, because less than two years later Ms. Ferri returned to Dr. Shankar with Luigi in tow. She was pregnant again — a surprise for her and her husband — and she wanted him to deliver her second baby.

“We were thrilled when we received the news of the second pregnancy,” said Ms. Ferri, “but we were also terrified, after what we’d been through with the first. There was no question that we would return to Dr. Ravi’s practice. He is a wonderful doctor, and his manner is so calm, so positive.”

A problem with placental implantation appeared to be what went wrong in her pregnancy with Luigi, and there was a 20 percent chance it would happen again, but the doctors, the physician’s assistants and the office staff all delivered reassurance as well as scheduling tests. “Of course there would be some anxiety until I held the baby in my arms,” said Ms. Ferri, “but I knew I was receiving the very best, most attentive and compassionate care.”

The pregnancy proceeded normally, and at 37 weeks, tests indicated that the baby’s lungs were fine and the time had come. On June 14, at the Katz Women’s Hospital at North Shore University Hospital, Dr. Shankar delivered 6-pound, 6-ounce Joseph Peter Ferri by cesarean section. He announced his arrival with loud yells — welcome sounds to his parents and everyone else in the delivery room. “We’re all thrilled at the outcome,” said Dr. Shankar.”

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